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首页> 外文期刊>Human reproduction update >Metformin versus clomiphene citrate for infertility in non-obese women with polycystic ovary syndrome: A systematic review and meta-analysis
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Metformin versus clomiphene citrate for infertility in non-obese women with polycystic ovary syndrome: A systematic review and meta-analysis

机译：二甲双胍与枸clo酸克罗米芬治疗非肥胖多囊卵巢综合征女性的不孕症：系统评价和荟萃分析

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Background: Recent studies suggest that metformin may be more effective in women with polycystic ovary syndrome (PCOS) who are non-obese. The objective here is to determine and compare the effectiveness of metformin and clomiphene citrate for improving fertility outcomes in women with PCOS and a BMI 32 kg/m 2 (BMI 32 kg/m 2 was used to allow for international differences in BMI values which determine access to infertility therapy through the public health system). Methods: Databases were searched for English language articles until July 2011. Inclusion criteria: women of any age, ethnicity and weight with PCOS diagnosed by all current criteria, who are infertile; at least 1000 mg of any type of metformin at any frequency, including slow release and standard release, compared with any type, dose and frequency of clomiphene citrate. Outcomes: rates of ovulation, live birth, pregnancy, multiple pregnancies, miscarriage, adverse events, quality of life and cost effectiveness. Data were extracted and risk of bias assessed. A random effects model was used for meta-analyses of data, using risk ratios (relative risk). Results: The search returned 4981 articles, 580 articles addressed metformin or clomiphene citrate and four randomized controlled trials (RCTs) comparing metformin with clomiphene citrate were included. Upon meta-analysis of the four RCTs, we were unable to detect a statistically significant difference between the two interventions for any outcome in women with PCOS and a BMI 32 kg/m. 2, owing to significant heterogeneity across the RCTs. Conclusions: Owing to conflicting findings and heterogeneity across the included RCTs, there is insufficient evidence to establish a difference between metformin and clomiphene citrate in terms of ovulation, pregnancy, live birth, miscarriage and multiple pregnancy rates in women with PCOS and a BMI 32 kg/m. 2. However, a lack of superiority of one treatment is not evidence for equivalence, and further methodologically rigorous trials are required to determine whether there is a difference in effectiveness between metformin and placebo (or no treatment) or between metformin and clomiphene citrate for ovulation induction in women with PCOS who are non-obese. Until then, caution should be exercised when prescribing metformin as first line pharmacological therapy in this group of women.
机译：背景：最近的研究表明，二甲双胍对非肥胖多囊卵巢综合征（PCOS）女性可能更有效。此处的目的是确定和比较二甲双胍和枸clo酸克罗米芬对改善PCOS和BMI <32 kg / m 2（BMI 32 kg / m 2的妇女在国际上具有不同的BMI值）的生育结果的有效性。确定通过公共卫生系统获得不孕治疗的途径）。方法：在数据库中搜索英语文章，直至2011年7月。纳入标准：根据当前所有标准诊断为PCOS的任何年龄，种族和体重的妇女，均不育。与柠檬酸克罗米芬的任何类型，剂量和频率相比，至少1000 mg任何类型的二甲双胍在任何频率（包括缓慢释放和标准释放）。结果：排卵率，活产，妊娠，多胎妊娠，流产，不良事件，生活质量和成本效益。提取数据并评估偏倚风险。使用风险比（相对风险），将随机效应模型用于数据的荟萃分析。结果：搜索返回4981篇文章，580篇涉及二甲双胍或柠檬酸克罗米芬的文章，并包括四项比较二甲双胍和柠檬酸克罗米芬的随机对照试验（RCT）。对这四个RCT进行荟萃分析后，我们无法检测出PCOS和BMI <32 kg / m的女性在两种干预措施之间的任何统计学差异。 2，由于RCT之间存在明显的异质性。结论：由于发现的RCT之间存在矛盾的发现和异质性，因此没有足够的证据证明PCOS和BMI <32的妇女在排卵，妊娠，活产，流产和多胎妊娠率方面存在柠檬酸二甲双胍和克罗米芬之间的差异。公斤/米2.然而，一种治疗方法的优越性并不能证明是等效的，因此需要进一步进行严格的方法学试验，以确定二甲双胍和安慰剂之间（或不进行任何治疗）或二甲双胍和柠檬酸克罗米芬排卵的有效性是否存在差异。非肥胖的PCOS妇女的诱导。在此之前，在此组女性中，在服用二甲双胍作为一线药物治疗时应谨慎行事。

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